Oregon Hastily Readies Aided Suicide Rules

Scrambling to implement the nation’s first law authorizing doctor-assisted suicide, the Oregon Health Division on Wednesday released emergency rules outlining physicians’ responsibilities when prescribing fatal doses of medication for terminally ill patients.

The rules, submitted to the state attorney general, require doctors to notify the state when they have written a prescription for a suicide, include a copy of the patient’s written request, and certify the circumstances of the patient’s death.

“If you sense a degree of anxiety in physicians and providers, I think it’s real, and I think it’s warranted. It’s a different paradigm than . . . we’ve been used to,” said Dr. Patrick Dunn, head of a 3-year-old task force drafting guidelines for health care providers on how to carry out assisted suicides.

Among the most immediate issues not answered in the law upheld by Oregon voters Tuesday is how to deal with relief care for patients who take a fatal dose but who do not die right away, and how to deal with the issue of patients who may choose suicide because they cannot afford medical or hospice care, task force leaders said.

“Not every Oregonian has health insurance. And some dying persons may feel some increased pressure to seek assisted suicide because they cannot afford comfort care . . . to avoid impoverishing their families,” said Susan Tolle, director of the center for ethics in health care at Oregon Health Sciences University and a member of the physicians’ task force.

The task force, which called a news conference to discuss issues in implementing the law, is scheduled to provide a detailed guidebook for doctors in the coming weeks. In the meantime, members said it is crucial that the focus on assisted suicide not take away from gains Oregon has made in end-of-life care for those who choose to die naturally.

Since the assisted suicide law was passed in Oregon in 1994, the state has become a leader in palliative care for the dying, ranking third in the number of terminal patients utilizing hospice care. The state has the lowest rate of in-hospital deaths and the highest rate of prescribed morphine for dying patients in pain.

Now, Tolle said, task force leaders worry that physicians may be reluctant to prescribe pain relief medication like morphine, which might hasten a patient’s death, for fear of becoming caught up in the legal constraints of assisted suicide.

State officials say there is no mechanism in the law for enforcement--no way to monitor, for example, whether physicians are complying with the required 15-day waiting period. Moreover, they said, the law, while restricting assisted suicides to Oregon residents, provides no definition of residency.

The Oregon Medical Assn., which supported this week’s ballot measure to overturn the law, said Wednesday that it is prepared to help carry it out.

“The fact is that the law is the law, and obviously we as an organization respect what the voters have done, and we are going to have to live with the law. That’s the way of democracy,” said Jim Kronenberg, associate executive director of the medical association.

“We are in the process right now of developing a very brief statement on what specifically physicians’ obligations, responsibilities and rights are under the law. We will provide that to our members on request,” Kronenberg said.

The full task force guidelines, upon which the medical association worked, are “intended to fill in a lot of the sort of empty spaces with something that is obviously new--and frankly totally alien--to most physicians’ experience,” he said.

Glen Gordon, a Eugene, Ore., physician and past medical association president who was a leader in the campaign to block repeal of the statute, said that the majority of Oregon doctors would participate in carrying out the new law.

“I think there are many physicians in Oregon who are ready and willing to participate, to help. That’s part of our profession, to help people,” Gordon said. “They will take on this responsibility with compassion, with care and with professionalism, and we will make sure that it works properly.”